The Supportive Community

PLEASE SCROLL DOWN FOR ARTICLEThis article was downloaded by: [EBSCOHost EJS Content Distribution - Current]On: 3 December 2010Access details: Access Details: [subscription number 925797205]Publisher RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UKJournal of Aging & Social Policy Publication details, including instructions for authors and subscription information:/smpp/title~content=t792303967The Supportive Community Ayelet Berg-Warman a ; Jenny Brodsky ba Myers-JDC-Brookdale Institute of Gerontology and Human Development, Jerusalem, Israelb Myers-JDC-Brookdale Institute, Jerusalem, IsraelTo cite this Article Berg-Warman, Ayelet and Brodsky, Jenny(2006) 'The Supportive Community', Journal of Aging &Social Policy, 18: 2, 69 — 83To link to this Article: DOI: 10.1300/J031v18n02_05URL: /10.1300/J031v18n02_05Full terms and conditions of use: /terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. 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The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.INTERNATIONAL VIEWThe Supportive Community:A New Concept for Enhancing the Quality of Life of Elderly Living in the Community Ayelet Berg-Warman, PhD Jenny Brodsky, MS Myers-JDC-Brookdale Institute, Jerusalem, Israel ABSTRACT.This study examines supportive community programs in Israel,which aim to improve the quality of life of the elderly.These in-novative programs pool existing resources to provide a benefits package that includes medical services,an emergency call switchboard,a “neigh-borhood facilitator,”and social activities.Data were collected in 2000-2001using qualitative and quantitative methods.The program provides specific services to meet needs that otherwise are not adequately ad-Ayelet Berg-Warman is Senior Researcher at Myers-JDC-Brookdale Institute of Gerontology and Human Development,Jerusalem,Israel.Her research interests in-clude evaluation of programs for elderly in the community.Jenny Brodsky is the Director of the Research Center on Aging at Myers-JDC-Brookdale Institute,Jerusalem,Israel.Her research interests include needs as-sessment and the organization of services for the elderly.Address correspondence to:Dr.Ayelet Berg-Warman,Research Center on Aging,P.O.B. 3886, Jerusalem, 91037 Israel (E-mail: ayeletb@.il).Journal of Aging & Social Policy, Vol. 18(2) 2006Available online at /web/JASP ©2006 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J031v18n02_0569D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010dressed.The major contributions of the program reported by the mem-bers was increasing their personal security (two-thirds),easing the burden on their children (one-third),and enabling them to remain at home (one-quarter).The supportive community program enriches the variety of services available,thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods.This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the el-derly’s essential needs,thereby maintaining their quality of life.[Article copies available for a fee from The Haworth Document Delivery Ser-vice:1-800-HAWORTH.E-mail address:<docdelivery@>Website:<>©2006by The Haworth Press,Inc.All rights reserved.]munity services,aging in place,elderly in the com-munity, supportive services INTRODUCTION The prevailing approach to services for the elderly in Israel supports their remaining at home and in the community,where they can maintain independent life-styles.This approach concords with the preferences of the elderly themselves,as found by studies conducted in Europe and the United States (Tinker,1997;Judge,1978;Woodruff &Applebaum,1996).An outgrowth of this approach has been the development in Is-rael of a nationwide network of services for the elderly,which includes home care,the Community Long-Term Care Insurance Law (under which formal care services are provided to disabled elderly living in the community),day care centers for the elderly,and the “supportive com-munity”program.This program aims to meet needs of the elderly that are not met by other community services,thereby improving the quality of their lives and enabling them to remain in familiar surroundings.The “supportive community”program was established some 15years ago by ESHEL-The Association for the Planning and Develop-ment of Services for the Aged in Israel and the Israel Ministry of Social Affairs.It is implemented by these two agencies,in cooperation with non-profit and for-profit agencies for the aged,and municipal and other local authorities.At present,some 20,000elderly people are covered by 120supportive communities in all sectors and areas of Israel;they con-stitute about 3%of all elderly living in the community in Israel.Any el-70JOURNAL OF AGING & SOCIAL POLICYD o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010derly person who lives in a neighborhood in which the program is implemented may join the program.Each specific supportive commu-nity serves about 200households;programs reach full capacity during the first three years of implementation (most of them much earlier).New programs in the same or other neighborhoods are developed ac-cording to a national program that reflects needs.Members pay monthly dues of approximately $22.00,which are subsidized by the Ministry of Social Affairs for elderly with low income,who thus pay only about 40%of this sum.About 40%of the program’s elderly members nation-wide are eligible for this subsidy.In addition,local governments pay some 10% of the program’s costs.This program is founded on an innovative,creative approach,which involves pooling existing resources in a “basket of services”or benefits package that is then offered to the target population.Four types of ser-vices are included in this core basket of services:medical services (comprising house calls by a physician for the nominal fee of about $5.00,and free ambulance service);an emergency call switchboard;a “neighborhood facilitator”;and social activities.The program does not offer home care or day care services.However,program staff are ex-pected to be familiar with the system of services and sensitive to changes in the elderly members’conditions,such that they will be able to refer them to services that meet their needs as these change.The “neighborhood facilitator”is usually employed full time;he is responsible for all of the households in the program,which typically number about 200and are distributed within a distinct geographic area of between five and ten kilometers.The “neighborhood facilitator”calls to ask members about their well-being,visits them at home,helps make small household repairs or procure a repairman,and may do some er-rands or deliver medications for a housebound member.Most of the neighborhood facilitators are age 50or older,good with their hands,and personable.The social activities offered as part of the program may in-clude lectures and courses at an existing neighborhood community center and trips;these activities are organized by a part-time social co-ordinator.In recent years,several countries have developed frameworks for el-derly living in the community.The Netherlands,Sweden,and Denmark have set policy that encourages the development of community hous-ing,as part of a general plan to keep institutions available for elderly who are more disabled.Models of this type,which contribute to delay-ing institutionalization by enabling the elderly to age in a familiar envi-ronment,have also been described in the literature (King,2000).One of Ayelet Berg-Warman and Jenny Brodsky 71D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010these frameworks is the “Naturally Occurring Retirement Community”(NORC),which is based on a concept similar to that underlying the sup-portive community.Developed in the states of New York and Washing-ton in the United States,NORCs also involve the pooling of resources to provide medical monitoring,meals-on-wheels,social and recreational services,shopping,transportation and escort services,home care ser-vices,and legal services (Administration on Aging,1995;Franklin,1998).This descriptive study examines the achievements of the supportive community in light of its goals;the program’s target population and whom it actually serves;and service utilization patterns–that is,whether members know about the services for which they are eligible as part of the program,and to what extent various services are used.It explores whether those who need the services offered actually seek them,and if not, why not; and whether those who seek help, receive it.The study further examines whether clients are satisfied with the pro-gram in general and with the neighborhood facilitator in particular,and what they perceive as the program’s contribution to their quality of stly,the study examines whether the members of these communi-ties still have unmet needs and,if so,what they are;and differences be-tween programs implemented by for-profit and by non-profit agencies.The purpose of this article is to share our experience with the imple-mentation of a program that improves the quality of life of elderly living in the community and does so in a cost-effective way.We hope that Is-rael’s experience may prove useful to the implementation of similar programs in other countries.METHODS The nature of this study is purely descriptive.Quantitative and quali-tative methods were used.Administrative data were gathered from all of the supportive community programs operating in Israel at the time of the study,in-depth interviews were conducted with 15program imple-menters and staff,and a structured questionnaire was used to interview 200members of four supportive communities,who were sampled ran-domly from a total of about 1,000members of these communities.Data were collected between 2000and 2001.These methods yielded infor-mation on the program’s implementation nationally and on its specific components.It should be noted that this study followed an earlier one conducted by Mizrahi and Himmelblau (1999)in 1997-1998.This en-72JOURNAL OF AGING & SOCIAL POLICYD o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010abled us to validate the study methods and to use the data obtained to examine changes in the program over time.The results presented in this article are based primarily on the find-ings from the questionnaires administered to the representative sample of program members.RESULTS The Target Population The supportive community program serves a diverse population of both disabled and semi-independent elderly of varying socioeconomic levels.The rates of women (67%),people age 80and over (30%),peo-ple who are unmarried (50%)–the vast majority of them widowed–and people who are disabled in activities of daily living (16%)are greater among members of supportive communities than among the total el-derly population in Israel living in the community (Brodsky et al.,2003).Six percent are disabled in one ADL;7%are disabled in two ADLs; and 4% are disabled in three or more ADLs.The in-depth study revealed that about 29%of the members of sup-portive communities receive assistance with personal care,most of it under Israel’s Community Long-Term Care Insurance Law,which,as noted,provides non-professional home care.About half of the members have a maid help with household chores,and most of them pay for maid services out-of-pocket.The majority (90%)of members have children living in Israel.Awareness of Services Offered Through the Supportive Community Program One of the study’s goals was to examine the extent to which members were familiar with the services to which they are entitled as part of theprogram.The findings reveal that not all members were aware of the services for which they were eligible.Eighty-three percent of them knew they could call for a physician through the program;of them,83%were aware that a physician house call incurred a fee.Seventy-five of the respondents knew that physician house calls were available 24hours a day,seven days a week.Only 26%of the respondents knew they would be reimbursed for ambulance service (see Table 1).Ayelet Berg-Warman and Jenny Brodsky 73D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010Use of the Program’s Services Use of the services provided through the program is primarily a func-tion of members’needs.However,it is also affected by factors such as their awareness of the availability of services and their satisfaction with the services actually provided.Household Repairs.Sixty-eight percent of the households had a need for home repairs during the year preceding the interview.Of them,36%(24%of all members)sought help from the program.Those who did not seek help from the program preferred to receive help from other sources,such as relatives,friends,or professionals.In addition,about one-quar-ter of those members who needed the repair service were not aware it existed.An even smaller portion of them did not use the service because they were disappointed with past repairs made in their homes through the program.Among those who did ask the neighborhood facilitator to make home repairs,79%–or 19%of the members–received his help (see Table 2).The data reveal that requests for assistance,the help actually pro-vided by the neighborhood facilitator,and satisfaction with the service were greater in for-profit programs than in those run by a non-profit agency.Medical Services.Two main types of medical service are providedthrough the supportive community program.To receive either of these,the member usually first calls the emergency switchboard.1.Physician house calls.Close to half (46%)of the members noted that,during the past year,they had felt ill and urgently needed a physi-cian to make a house call.Eighty-seven percent of them (40%of all74JOURNAL OF AGING & SOCIAL POLICYTABLE 1.Members’Awareness that Certain Medical Services Are Offered Through the Program (% of all Program Members)ServicePercentage of Members Who Knew the Service Was Available Physician house calls83Hours of physician house calls75Physician house calls available on weekends and holidays 75Physician house calls cost money 69Cost of physician house calls 66Reimbursement for ambulance service 26D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010members)sought assistance from the program,and 88%of them (35%of all members)had a physician sent to their homes (see Table 2).In other words,a physician was sent to the homes of most (76%)of those who needed such a service.Of the remaining 24%who reported asking for a physician to make a house call but not receiving one,most reported that this was because their problems had resolved themselves,and they no longer needed the service.A few of those who needed the service never asked for it,mostly because they did not know it was available.It should be noted that the program promises to send a physician within one and a half hours of the request;however,in rural areas,this maytake pared to the previous evaluation study (Mizrahi &Himmelblau,1999),an increase was noted in the need for physician house calls and in the use of this service–perhaps because the percent-age of members disabled in functioning had increased due to the aging of the elderly population.2.Ambulance services.Twenty-two percent of the respondents re-ported needing to reach a hospital urgently at least once during the past Ayelet Berg-Warman and Jenny Brodsky 75TABLE 2. Needs for and Use of Services Available Through the Program ServicePercentage (N = 205)Emergency call centerCalled the center at least once during the past year80Household repairs (N = 157 households)Needed a household repair 68Of them: sought help from the program 36 (24% of all members)Of them: the neighborhood facilitator made the repair*79 (19% of all members)Physician Felt ill and needed a physician 46Of them: sought help from the program 87 (40% of all members)Of them: a physician was sent**88 (35% of all members)Ambulance Needed an ambulance 22Of them: sought help from the emergency call center 41 (9% of all members)Social activities Participate in most/some activities 30*Most of those who did not receive the service preferred to receive help from relatives,friends,and professionals.**Most of those who did not receive the service cancelled their call because their problem had re-solved itself.D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010year;41%of them (9%of all members)called the program’s emergency switchboard for an ambulance (see Table 2).However,most members who needed an ambulance called one themselves or reached the hospital on their own.Note that about one-fifth of the members who needed this service did not know it was available through the program.It is also worth noting that there was an increase in the need for an ambulance compared to the previous study (Mizrahi &Himmelblau,1999),here,too,most likely because of an increase in the percentage of members disabled in functioning, an outgrowth of the aging of the population.Social Activities.Various social activities are offered through the supportive community program,some of them regular classes,lectures,and the like,and some occasional trips and special events.Efforts are made to plan activities that will be to the members’liking;at the time of the study,the most common activity was lectures.Members are in-formed of social activities either by telephone or through flyers distrib-uted to their homes.Thirty percent of the respondents reported usually or sometimes participating in the social activities (see Table 2).Larger percentages of women,elderly who live alone,and semi-independent elderly participate in the social activities offered through the program.The main reasons cited for not participating in the social activities were health problems or difficulty getting to the activity (45%);or a lack of time or inconvenient activity times (30%).Larger rates of participation in social activities were found in programs run by non-profit organiza-tions than in for-profit programs.It was interesting to note that the rates of participation in social activities had decreased since the previous evaluation (Mizrahi &Himmelblau, 1999).About one-quarter of the members reported often feeling lonely,and about 40%of them reported being dissatisfied or not so satisfied with how they spend their time.These responses signal the existence of un-met needs,which should be taken into account when planning program activities.Unmet Needs.An additional goal of the study was to identify unmet needs among program members,with the intention of considering how to meet them.To this end,we examined the need for services not cur-rently included in the core basket of services.One of the most signifi-cant of these was the need for an escort to medical examinations or treatments–cited by 61%of the supportive community members.One percent of those who needed this service received it from their neigh-borhood facilitator, even though he was not obligated to provide it.About half (49%)of the respondents reported that,during the past year,they had needed help obtaining medications,shopping,or arrang-76JOURNAL OF AGING & SOCIAL POLICYD o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010ing for laboratory tests when they were ill.Five percent of them (or 3%of all members)asked the neighborhood facilitator for help,and half of them received it,even though he was not obligated to provide it (this service is not in the core basket).Most of the members asked a relative for help,and 3%of those who needed assistance did not ask anyone for help.Four percent reported having forfeited taking medication because no one could bring it to them.Satisfaction with the Program and Its Perceived Contribution The generally high satisfaction with the program is reflected in the minimal number of members who leave it.During the period of study,an average of 11people dropped out of each program,mainly because they either moved to another neighborhood,in which the program was not offered,or died.A very few left the program because they were dissatisfied with it.In response to a direct question about satisfaction with the program,80%of the members reported being satisfied with it overall;15%re-ported being only somewhat satisfied;and 5%reported being dissatis-fied.We also asked the members what the program contributed to them:69%of them said it gave them a sense of personal security;32%re-ported that it eased the burden on their children;and 24%reported that it enabled them to continue living in their homes.Examination of satisfac-tion with each of the services provided by the program revealed that members were most satisfied with the emergency switchboard (91%of those who used this service were satisfied with it).Moreover,this was found to have the strongest correlation with satisfaction with the pro-gram,in general.Satisfaction with the neighborhood facilitator,which was 86%,also had a strong correlation with overall satisfaction.High levels of satisfaction were also recorded among those who used the ser-vices of a physician (83%)and those who participated in social activi-ties (82%).Relatively low levels of satisfaction were found among those who used ambulance services (75%)or needed household repairs (66%) (see Figure 1).We examined the reasons behind the satisfaction or dissatisfaction with these services and found that satisfaction with the emergency switchboard was due primarily to the rapid response of its operators.Satisfaction with the neighborhood facilitator was ascribed primarily to his courtesy and willingness to help,and satisfaction with social activi-ties was due to the activities being interesting and providing an opportu-Ayelet Berg-Warman and Jenny Brodsky 77D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010nity to meet new people.Interestingly,there was very little turnover among neighborhood facilitators.Members were more satisfied with the medical care than with the time it took a physician to arrive at their homes.Those who called an ambulance through the program were satisfied with the time it took to arrive and with the medical care provided.We also found reports of dissatisfaction.Although the majority of members were satisfied with the neighborhood facilitator,9%of them reported being dissatisfied because they found him impolite and unwill-ing to help.The neighborhood facilitator’s attitude was a source of both satisfaction and disappointment.It is important for members to feel comfortable asking the neighborhood facilitator for help,that he be easy to contact,that he visit the homes of members (especially those who are disabled),and that he be both courteous and willing to help.This will in-crease satisfaction with his performance and,consequently,with the program as a whole,as satisfaction with the neighborhood facilitator appears to explain overall satisfaction, at least in part.There seems to be room for improvement in the household repairs service.Twenty-eight percent of those members who needed this ser-vice were not aware it was offered.Others who needed repairs felt that the neighborhood facilitator was not sufficiently or not at all helpful,or was not involved in obtaining a repair service (21%);that it took too100%80%60%40%20%0%Overall satisfactionEmergency switchboard Neighborhood facilitatorPhysician SocialactivitiesAmbulanceHousehold repairsSatisfiedso satisfiedNot satisfied51580639131186116832168212137527766FIGURE 1. Satisfaction with the Program Overall and with Its ComponentsD o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010long for the repair to be made;and that no one followed up the repair to make sure the problem had been solved (about 87%).It appears that the lack of a clear definition of the service,the time frame within which it is to be provided,and the nature of the repairs that the program will cover contribute to problems with this service.Satisfaction with the repairs service was greater among members of programs implemented by for-profit agencies than among members of programs implemented by non-profit agencies.Regarding dissatisfaction with the medical services offered by the program,the respondents felt it took too long for an ambulance or phy-sician to come to their homes (42%of the members who had a physician make a house call).We would note that this reflects subjective percep-tion;in most cases,a physician will reach the member’s home within an hour and a half.Nevertheless,a small percentage (7%)reported waiting two or more hours for a physician.This information was used by service providers to improve this service and adapt it to the expectations of elderly members.Criticisms of social activities primarily addressed their quantity–that is,that there were not enough activities (especially trips)(12%)–but also their quality,especially that the trips were not sufficiently interest-ing (7%).Transportation was also said to be problematic (5%).How-ever,this percentage may actually be higher,as members who did not respond to this question may not participate in activities simply because they have difficulty getting to them.POLICY IMPLICATIONSMost elderly people prefer aging in their own homes,in familiar sur-roundings,and living in proximity to family.The supportive commu-nity program provides services that improve its members’quality of life and enables them to remain in the community by giving them a sense of security and well-being.Indeed,this study found that,in general,the program meets the needs of the target population,and its members are satisfied with the services they receive.Given the current trend of enabling the elderly to remain in the community for as long as possible,this model may be suited to other countries as well.To those interested in developing programs for the el-derly based on a similar approach,we recommend several directions for developing policy and services,based on our findings about supportive communities in Israel.D o w n l o a d e d B y : [E B S C O H o s t E J S C o n t e n t D i s t r i b u t i o n - C u r r e n t ] A t : 06:54 3 D e c e m b e r 2010。